Intended for healthcare professionals


Should psychiatrists protect the public?

BMJ 2003; 326 doi: (Published 22 February 2003) Cite this as: BMJ 2003;326:406

A new risk reduction strategy, supporting criminal justice, could be effective

  1. Jeremy Coid, professor of forensic psychiatry, Queen Mary College (,
  2. Tony Maden, professor of forensic psychiatry, Imperial College (
  1. Queen Mary College, Forensic Psychiatry Research Unit, St Bartholomew's Hospital, London EC1A 7BE
  2. Academic Centre, Trust Headquarters, West London Mental Health Trust, Southall, Middlesex UB1 3EU

    As conservative members of the middle classes, most psychiatrists probably support recent criminal legislation designed to improve public protection by introducing tighter controls on high risk offenders. Psychiatrists have always contributed to public protection by detaining dangerous patients. Yet proposed mental health legislation emphasising public protection has provoked an outcry.1 The government is accused of circumventing human rights legislation by concealing preventive detention in medical disguise, with establishment figures in forensic psychiatry even urging withdrawal from psychiatry's already limited participation in public protection.24 The Royal College of Psychiatrists has stated unequivocally that the only rationale for psychiatric intervention is for the benefit of patients' health and public protection is secondary. 5 The rhetoric should now cool while psychiatry determines its role in an alternative public protection framework.

    The debate's moral focus has largely neglected two pragmatic questions. Firstly, is the health service equipped to take the lead in public protection? Secondly, can the philosophy underpinning strategy of the Department of Health for mental health be reconciled to the public protection agenda of the Home Office?

    Many …

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